Killian, Phoebe NEW YORK STATE DEPARTMENT OF HEALPH it4J
Vital Records Section Burial - Trahsit Permit
Name First Middle Last Sex
Phoebe Jean Killian Female
Date of Death Age If Veteran of U.S. Armed Forces,
0 8/1 1 /2016 77 War or Dates
Place of Death Glens Falls Hospital, Institution or
WCity, Town or Village Street Address Glens Falls Hospital
itt Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
11.1 Circumstances Investigation
tu Medical Certifier Name Title
Nauved Siddiqui
Address
100 Park St. Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
abit, Town or Village Glens Falls
❑Burial Date Cemetery or Crematory
08/11 /2016 Pine View Crematorium
0 Entombment Address
> ®Cremation 21 Quaker Rd. Queensbury, NY 12804
Date Place Removed
Z❑Removal and/or Held
C and/or Address
Hold
ta
0 Date Point of
Transportation Shipment
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to MB Kilmer FH OR1gi�rration Number
9
Name of Funeral Home ��
tcYregroadway Fort Edward, NY 12828
Name of Funeral Firm Making.Disposition or to Whom
Remains are Shipped, If Other than Above
Address
IIu
fiu
Permission is hereby granted to dispose of the human remains des ibedb above as i i ted.
Date Issued AA!I Registrar of Vital Statistics Al
(signature)
District Number ,5 0/ Place ripe ti (yam," "'I DPyN
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
IJ Date of Disposition 48-/Z_/ , Place of Disposition �i)?Q L) fetid Ccedizt,frioy
(address)
ili
til
IX (section) lot number) (grave number)
0
0 Name of Sexton or ers n . Charge of Premises L-i%a-rt 6-c e
6 (please print)
Signature 'ark- Title ���'e-m a-
(over)
DOH-1555 (02/2004)